Provider Demographics
NPI: | 1770025892 |
---|---|
Name: | EYEWORKS AT WEST 7TH |
Entity Type: | Organization |
Organization Name: | EYEWORKS AT WEST 7TH |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CHU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD |
Authorized Official - Phone: | 817-346-7077 |
Mailing Address - Street 1: | 3017 W 7TH ST |
Mailing Address - Street 2: | SUITE 100 |
Mailing Address - City: | FORT WORTH |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76107-2223 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 817-346-7077 |
Mailing Address - Fax: | 817-346-6998 |
Practice Address - Street 1: | 3017 W 7TH ST |
Practice Address - Street 2: | SUITE 100 |
Practice Address - City: | FORT WORTH |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76107-2223 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-346-7077 |
Practice Address - Fax: | 817-346-6998 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-11-07 |
Last Update Date: | 2016-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 6328TG | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |